缺血性卒中患者服用阿司匹林后再发脑梗死的危险因素分析

Analysis of risk factors of ischemic stroke recurrence of ischemic stroke patients using aspirin

目的探讨缺血性卒中患者服用阿司匹林进行二级预防后再发脑梗死的危险因素。方法收集我院缺血性卒中265例患者的资料：年龄、性别、高血压病、冠心病、糖尿病、高脂血症、高同型半胱氨酸血症病史、吸烟史等情况,并对在服药期间患者各项卒中危险因素的控制情况进行随访：包括血压、血脂、血糖、同型半胱氨酸水平,并依据调查结果筛选出水平高于正常的患者。随访3年,患者分为缺血性卒中再发组和缺血性卒中无再发组两组,分析以上因素在两组间的差异。结果 265例患者入选,5例因其他系统疾病死亡失访,8例因出现胃肠道并发症停用阿司匹林,252例参加随访的缺血性卒中病例中54例再发,再发率21.4%。单因素分析显示,缺血性卒中再发组中合并高脂血症、糖尿病或高同型半胱氨酸血症的患者比例显著高于缺血性卒中无再发组;缺血性再发组在服用阿司匹林期间血浆总胆固醇（TC）及低密度脂蛋白（LDL）水平高于正常或血脂3项都高于正常、血糖水平高于正常、同型半胱氨酸（Hcy）水平高于正常的患者比例明显高于缺血性卒中无再发组。多因素分析显示,服用阿司匹林期间,TC及LDL高于正常或血脂3项都高于正常[比值比（odds ratio,OR）=2.54;95%置信区间（confidenceinterval,C I）1.33~5.36,P=0.007]、血糖水平高于正常（OR=2.83;95%C I 1.49~5.61,P=0.003）、血浆HCY水平高于正常（OR=2.44;95%C I 1.29~5.28,P=0.009）与服用阿司匹林进行缺血性卒中二级预防患者的脑梗死再发独立相关。结论服用阿司匹林期间,TC及LDL高于正常或血脂3项都高于正常、空腹血糖水平高于正常以及同型半胱氨酸水平高于正常是服用阿司匹林预防进行二级预防患者缺血性卒中再发的独立危险因素。

Objective To investigate the risk factors of ischemic stroke recurrence of ischemic stroke patients using aspirin.Methods Data of 265 ischemic stroke patients using aspirin in our hospital were collected.Age,sex,history of hypertension,coronary disease,diabetes,hyperlipidemia,hyperhomocysteinemia and smoking were recorded.Levels of blood pressure,blood-fat,blood sugar and homocysteine during aspirin using were followed up and patients with higher levels were selected.We followed up the patients for 3 years.Patients were divided into 2 groups,ischemic recurrence group and non-recurrence group.We analyzed the difference of risk factors between 2 groups.Results Two hundred and sixty-five cases were included in the present study.5 of them died of other system diseases and 8 of them suspended using aspirin because of gastrointestinal complication.54 of 252 patients（21.4%）had ischemic stroke recurrence.Single factor analysis showed that history of diabetes,hyperlipidemia or hyperhomocysteinemia were more frequent in ischemic recurrence group.The rate of patients with high level of TC and LDL（or TC,LDL and TG）,blood sugar or Hcy than normal in ischemic recurrence group was higher than that in non-ischemic recurrence group.Logistic regression analysis showed that during the period that patients using aspirin,level of TC and LDL（or TC,LDL and TG）was higher than normal（OR=2.54;95%CI=1.33～5.36,P=0.007）,level of blood sugar was higher than normal（OR=2.83;95%CI=1.49～5.61,P=0.003）,and level of Hcy was higher than normal（OR=2.44;95%CI=1.29～5.28,P=0.009）.They were the independent risk factors of ischemic stroke recurrence for ischemic stroke patients using aspirin.Conclusion On medication of aspirin,higher level of TC and LDL（or TC,LDL and TG）,higher level of blood sugar and higher level of Hcy are the independent risk factors of ischemic stroke recurrence for patients using aspirin for the secondary prevention of stroke.